Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through prevention and relief of suffering by means of early identification, assessment and treatment of pain, and other problems – physical, psychosocial, and spiritual. It is estimated that in India the total number of people who need palliative care is likely to be 5.4 million people a year. Though palliative care services have been in existence for many years, India ranks at the bottom of the Quality of Death index in overall score. However there has been steady progress in the past few years through community-owned palliative care services. One of the key objectives of the National Programme for prevention and control of cancer, diabetes, cardiovascular diseases, and stroke is to establish and develop capacity for palliative and rehabilitative care. Community models for the provision of home-based palliative care is possible by involving community caregivers and volunteers supervised by nurses trained in palliative care. Training of medical officers and health care professionals, and sensitization of the public through awareness campaigns are vital to improve the scope and coverage of palliative care. Process of translating palliative care plan into action requires strong leadership, competent management, political support and integration across all levels of care.

Background: A large number of patients with chronic diseases like, cancer are cared for in homes by the family members in India. The vital role that these family members play as “caregivers” is well recognized, however, the burden on them is poorly understood. Aims: To assess burden and to determine the predictors of burden on family caregivers of cancer patients. Setting And Design: A cross-sectional, hospital based study conducted in National Capital Territory of Delhi. Materials And Methods: 200 family caregivers of cancer patients were selected by systematic random sampling and interviewed using standard, validated Hindi version of Zarit Burden Interview. Statistical Analysis: Univariate analysis and multivariable logistic regression were carried out using Statistical Package for the Social Sciences software (version 17.0). Results: The study population consisted of 90 (45%) males and 110 (55%) female caregivers aged 18-65 years. 113 (56.5%) caregivers reported no or minimal burden while 75 (37.5%) caregivers reported mild to moderate burden. Using logistic regression marital status, education and type of family of caregivers, occupation of cancer patients and type of treatment facility were found to be the predictors of burden on caregivers. Conclusion: In view of the substantial burden on family caregivers coupled with lack of adequate number of cancer hospitals, there is a public-health imperative to recognize this important group. All levels of health-staff in cancer hospitals in developing countries should be sensitized to the various burdens faced by family caregivers.

Cancer is a manifestation of dysregulated gene function arising from a complex interplay of oncogenes and tumor suppressor genes present in our body. Cancer has been constantly chased using various therapies but all in vain as most of them are highly effective only in the early stages of cancer. Recently, RNA interference (RNAi) therapy, a comparatively new entrant is evolving as a promising player in the battle against cancer due to its post-transcriptional gene silencing ability. The most alluring feature of this non-invasive technology lies in its utility in the cancer detection and the cancer treatment at any stage. Once this technology is fully exploited it can bring a whole new era of therapeutics capable of curing cancer at any stage mainly due to its ability to target the vital processes required for cell proliferation such as response to growth factors, nutrient uptake/synthesis, and energy generation. This therapy can also be used to treat stage IV cancer, the most difficult to treat till date, by virtue of its metastasis inhibiting capability. Recent research has also proved that cancer can even be prevented by proper modulation of physiological RNAi pathways and researchers have found that many nutrients, which are a part of routine diet, can effectively modulate these pathways and prevent cancer. Even after having all these advantages the potential of RNAi therapy could not be fully tapped earlier, due to many limitations associated with the administration of RNAi based therapeutics. However, recent advancements in this direction, such as the development of small interfering RNA (siRNA) tolerant to nucleases and the development of non-viral vectors such as cationic liposomes and nanoparticles, can overcome this obstacle and facilitate the clinical use of RNAi based therapeutics in the treatment of cancer. The present review focuses on the current status of RNAi therapeutics and explores their potential as future diagnostics and therapeutics against cancer.

Applications of nanotechnology in medicine and cancer are becoming increasingly popular. Common nanomaterials and devices applicable in cancer medicine are classifiable as liposomes, polymeric-micelles, dendrimers, nano-cantilevers, carbon nanotubes, quantum dots, magnetic-nanoparticles, gold nanoparticles (AuNPs) and certain miscellaneous nanoparticles. Here, we present review of the structure, function and utilities of the various approved, under trial and pretrial nanodevices applicable in the cancer care and medicine. The liposomes are phospholipid-vesicles made use in carrying drugs to the target site minimizing the bio-distribution toxicity and a number of such theranostics have been approved for clinical practice. Newly worked out liposomes and polymeric micelles are under the trail phases for nano-therapeutic utility. A multifunctional dendrimer conjugate with imaging, targeting and drug molecules of paclitaxel has been recently synthesized for cancer theranostic applications. Nano-cantilever based assays are likely going to replace the conventions methods of chemical pathological investigations. Carbon nanotubes are emerging for utility in regenerative and cancer medicine. Quantum dots hold great promise for the micro-metastasis and intra-operative tumor imaging. Important applications of magnetic nanoparticles are in the cardiac stents, photodynamic therapy and liver metastasis imaging. The AuNPs have been employed for cell imaging, computed tomography and cancer therapy. Besides these categories, miscellaneous other nanoparticles are being discovered for utility in the cancer diagnosis and disease management. However, the use of nanoparticles should be cautious since the toxic effects of nanoparticles are not well-known. The use of nanoparticles in the clinical practice and their toxicity profile require further extensive research.

Objective: Cancer is a major health problem in many countries including India. Since Cancer Registries are incomplete in India, only a few epidemiological studies have been done so far. The objective was to determine the leading causes of cancer in a tertiary care hospital and compare the incidences of different types of cancer with the incidences in India and developed countries.Materials And Methods: An epidemiological study was done to collect data from pathology records of 1003 cancer cases during 6-month period in the year 2010. The data was collected in a computer and the data was utilized to make tables and histograms.Results: Of the 1003 cases, the leading cancer site was breast, followed by colon and rectum, lymph node and stomach. The leading cancer site for men was colon and rectum and for women was breast. Conclusion: Cancer incidence is now low in India, a developing country, compared to developed Western countries. However, some cancers, like breast and colon and rectum cancers are increasing every year.IMPACT: The findings of this study support that cancer incidence is increasing in India and more epidemiological studies are needed.

Background: Cancers of the uterine cervix, breast, and oral cavity accounted for 134,420, 115,251, and 24,375 cases, respectively, and were responsible for 52.8% of the total cancers among women in India in 2008. Aim: The major objectives were to create awareness regarding common cancers among women, to detect pre-cancers of the uterine cervix and oral cavity, and early cancers of the breast, uterine cervix, and oral cavity, by conducting screening with simple, low-cost technology, within the community, and to facilitate confirmation of diagnosis among the screen positives and treatment and follow-up among the diagnosed cases. Settings And Methods: This is a community-based screening program for early detection of breast, uterine cervix, and oral cancers, being implemented among the socioeconomically disadvantaged women in Mumbai, India. The process involves selection of clusters, household surveys, health education, and screening the eligible women for breast, uterine cervix, and oral cancers, by primary healthcare workers, at a temporarily set-up clinic within the community. The program is planned to cover a 125,000 disadvantaged population in five years. Results: Twenty-one thousand and fifteen people, with 4009 eligible women, have been covered to date. The compliance for screening for breast, cervix, and oral cavity has been 85, 70, and 88% and the screen positivity rates are 3.9, 14.9, and 3.9%, respectively. Twenty-seven oral pre-cancers, 25 cervix pre-cancers, one invasive cancer of the breast, two of the cervix, and one oral cavity cancer have been diagnosed among the screened women and all of them have complied with the treatment. Conclusions: The program is raising awareness about the common cancers and harms of tobacco among the disadvantaged women population in Mumbai. It is also helping in detecting pre-cancers and cancers among asymptomatic women and is assisting them in receiving treatment.

The cancer awareness assessment project: A small-scale survey across people with different levels of education in Mysore, IndiaA Sheshachalam, AR ChakravarthyJanuary-March 2015, 52(1):153-155DOI:10.4103/0019-509X.175574 PMID:26838007

Aim: To assess the cancer awareness in respondents, their knowledge about the nature of cancer as a disease, its diagnosis and treatment, warning signs, environmental risk factors and conceptions of how risk factors work, as well as willingness to participate in screening programs if available. Methodology: Cancer awareness is an increasingly important issue in light of increasing incidence and associated healthcare costs, as well as the presence of risk management strategies. In this study, 453 people, drawn from several educational institutes/workplaces, were surveyed with respect to cancer awareness. The test sample included pre university students, undergraduates, and postgraduate students/workers. We checked for variations in cancer awareness across multiple educational levels to determine whether there was variation in levels of cancer awareness across educational classes. Results: We found that confidence in perception of cancer awareness, and awareness itself, was not very high, and only postgraduates had a nuanced appreciation of some of the complexities of cancer epidemiology, and even then only moderately. Conclusion: The conclusions of the study point towards the need for optimal policymaking in the development of cancer awareness in the population.

Background: There is an indication of the possibility of the direct or indirect influence of trace element in the development and prevention of malignant diseases, the contribution of the trace elements in the etiology of breast cancer has been under scrutiny. Aims: The aim of this study was to determine the serum concentration of trace element in serum of female patients with breast cancer in comparison with healthy controls. Settings: Breast Clinic of the Department of Surgery LAUTECH University teaching hospital Osogbo, in south-western Nigeria. Materials And Methods: A cross-sectional age matched controlled prospective study wherein the venous blood sample of 30 patients with breast cancer and 30 healthy volunteers as controls were analyzed using atomic absorption spectrophotometry. The collected data were analyzed using statistical package for the social sciences (SPSS Inc) 16. Result: The mean serum concentration of the copper, zinc and selenium were 95.3 ± 4.9 ug/dl and 65.2 ± 15 ug/dl, 62.7 ± 15.7 ug/dl and 93.5 ± 7.2 ug/dl, 45.0 ± 4.6 ug/l and 76.4 ± 8.9 ug/l in the two groups respectively. The concentrations of copper and copper-zinc ratio (C/Z) were significantly higher in the cancer bearing group compared to the controls (C/Z 1.6 ± 0.5 against 0.70 ± 0.14 the P < 0.01). The concentration of zinc and selenium in the venous blood of the breast cancer patients showed inverse relationship while that of the control showed a direct relationship (−0.03 against 0.09). In the breast cancer patients the correlation of copper and zinc, copper and selenium and zinc and selenium showed inverse relationships, none of the relationships was statistically significant. Conclusion: We found a significant association between the serum concentration of trace elements and breast cancer.

Background: The three direct factors that could lead cancer patients to anemia, apart from therapy are iron deficiency, inflammatory cytokines surge and decreased erythropoietin (Epo). Our aim was to quantify biochemical and hematologic markers serum Epo, ferritin (Fe) and tumor necrosis factor-alpha (TNF-α) along with hemoglobin (Hb) to understand the associations between these factors, patient characteristics and anemia. Materials And Methods: The study group consisted of 100 anemic cancer patients and 80 controls. Biochemical marker levels were determined by the enzyme linked immunosorbent assay on an autoanalyser. Univarient analysis, t-test, ANOVA, Bonferroni test, linear regression was performed to find correlations and associations among various factors. Results: The baseline serum Epo (153.07 ± 173.88 vs. 23.607 ± 36.462) and Fe levels (233.53 ± 257.12 vs. 23.06 ± 20.04) were adequately high in cases compared with that controls (P ≤ 0.001). Considerable raise in TNF-α levels was also observed (16.26 ± 13.44 vs. 11.2375 ± 4.84) (P = 0.001). TNF-α correlated positively (P = 0.022) with Epo and Fe (P = 0.000), which was also evident from large effect size of Epo (r2 = 0.414), TNF-α (r2 = 0.369), Hb (r2 = 0.226). Epo and Hb were negatively correlated (β = −0.375, P = 0.001) and Epo production was found to be appropriate for the degree of anemia (O/P ratio of 3.51 ± 1.26 vs. 1.43 ± 0.47). A strong association was seen between Hb, Epo and TNF-α in hematological and gynecological malignancies for different grades of anemia. Men were more prone to life-threatening anemia (13%) than women (9%). Conclusion: Anemia in cancers was not because of inadequate Epo or Fe levels, but because of improper Epo response. Further studies on molecular analysis of Epo, biochemical and molecular interplay between Epo and TNF-α could explain a rationale for anemia in cancers.

Introduction: Concurrent with the progression of a non- diseased epithelium to the pre-cancerous epithelium to carcinoma, the stroma also undergoes modifications. Myofibroblasts are important stromal cells that play a crucial role in carcinogenesis. The current study investigated the presence of myofibroblasts in healthy oral mucosa, potentially malignant disorders (PMDs) and squamous cell carcinoma (SCC). Materials And Methods: The study material consisted of a total of 106 samples categorized into three groups, namely, Group I - Oral SCC (OSCC) (n = 42), Group II – PMDs (n = 32) and Group III – Oral healthy mucosa (n = 32) subjected to immunohistochemical analysis using alpha Smooth Muscle Actin. Results: Among the 42 cases of OSCC, the staining index was negative in 23 cases (54.7%), low in 9 cases(21.4%) and moderate in 10 cases (23.8%). The stroma of cases of verrucous carcinoma, cases of Hyperkeratosis with epithelial dysplasia, 77.5% of the cases of oral Submucous Fibrosis (OSMF) and healthy oral mucosa were devoid of myofibroblasts resulting in a grade of “0” in all cases.Two of the cases of OSMF (12.5%) showed low staining index for myofibroblast. There was a significant difference in the myofibroblasts expression between the Groups (Kruskal-Wallis test P<0.001). Conclusion: The findings of the current study justify “myofibroblast” as one among the key stromal element in tumor progression. Future studies involving a larger sample size along with follow up of patients with PMDs are essential to identify the exact stage in which they emerge in the stroma of these lesions.

Background: Population aging is one of the most distinctive demographic events of this century. United Nations projections suggest that the number of older persons is expected to increase by more than double from 841 million in 2013 to >2 billion by 2050. It is estimated that 60% of the elderly patients may be affected by cancer and may present in the advanced stage. The aim of this paper was to develop a brief cancer-specific comprehensive geriatric assessment tool for use in a geriatric population with advanced cancer that would identify the various medical, psychosocial, and functional issues in the older person.Methods: Literature on assessment of geriatric needs in an oncology setting was reviewed such that validated tools on specific domains were identified and utilized. The domains addressed were socioeconomic, physical symptoms, comorbidity, functional status, psychological status, social support, cognition, nutritional status and spiritual issues. Validated tools identified were Kuppuswamy scale (socioeconomic), Edmonton Symptom Assessment Scale (Physical symptoms) and SAKK cancer-specific geriatric assessment tool, which included six standard geriatric measures covering five geriatric domains (comorbidity, functional status, psychological status, social support, cognition, nutritional status). The individual measures were brief, reliable, and valid and could be administered by the interviewer.Conclusion: The tool was developed for use under the geriatric palliative care project of the department of palliative medicine at Tata Memorial Hospital, Mumbai. We plan to test the feasibility of the tool in our palliative care set-up, conduct a needs assessment study and based on the needs assessment outcome institute a comprehensive geriatric palliative care project and reassess outcomes.

Background: Oral mucositis is one of the most common side effects of cancer therapy with no definite treatment. Phenytoin has positive effects on healing of mucosal and dermal wounds. In this study efficacy of 1% phenytoin mouthwash on severity of mucositis (on the basis of WHO scale), pain relief (based on Visual Analogue Scale), and improvement of patients' quality of life (on the basis of EORTC-QLQ-H and N35 questionnaire) was evaluated. Materials And Methods: In a pilot -double-blind randomized clinical trial, eight patients in study group were given 1% phenytoin mouthwash while eight patients in control group used normal saline. Data analysis was performed by Mann-Whitney and Repeated Measured ANOVA tests. Results: Reduction of mucositis severity was observed, but the difference was not significant. On the other hand, patients on phenytoin therapy had better pain relief (VAS# 6.75 ± 1.58 at the beginning of the study reached to # 3.75 ± 1.16 after 3 weeks in phenytoin group) and improvement in quality of life (score of QOL was 70.63 ± 5.5 that reached to 63.61 ± 6.39 in phenytoin group) than normal saline group significantly (P < 0.05). Conclusion: One percent phenytoin mouthwash caused pain relief and improvement of life quality significantly in patients with mucositis due to cancer therapy, but it did not reduce the severity of mucositis in a statistically significant scale.

Background: This study aimed to evaluate the expression of miR-17-92 host gene (MIR17HG), in gastric cancer and paired normal adjacent tissues for the 1st time. Methods: Using quantitative real-time-polymerase chain reaction, the MIR17HG expression was assessed in 30 paired tumoral and nontumoral gastric tissue samples. Results: Our results showed that this transcript was significantly underexpressed in gastric tumors compared with normal ones. Furthermore, there was an association between the expression levels of MIR17HG and gastric cancer grades and stages. Moreover, the expression level of MIR17HG was conversely associated with the size of tumoral specimens in early stages (stages I and II). We also observed an association between the presence of metastasis and lower expression of MIR17HG. Conclusion: Our results suggest that MIR17HG gene expression is dysregulated in gastric cancer in which it may indicate a tumor suppressive function of this miRNA cluster host gene in gastric cancer.

Bursectomy for gastric cancer: What does the evidence indicate?SG Barreto, A Perwaiz, A Singh, T Singh, A ChaudharyJanuary-March 2015, 52(1):36-38DOI:10.4103/0019-509X.175564 PMID:26837966

Radical resection of the bursa omentalis (radical bursectomy) as part of a curative resection for gastric cancer has been advised for close to a century. However, the postulated associated morbidity and lack of a clear benefit in terms of survival preclude its routine use. To objectively review the available evidence on the role of bursectomy as part of a curative resection for gastric cancer. A systematic search of the scientific literature was carried out using Embase, PubMed, MedLine and the Cochrane central register of controlled trials for the years 1965-2013 to obtain access to all publications, especially randomized controlled trials (RCTs), systematic reviews and meta-analyses involving bursectomy in gastric cancer with the appropriate specific search terms, namely, “bursectomy,” “stomach cancer,” “gastric cancer,” “survival,” “morbidity,” “outcomes” and “RCTs”. Using the above search strategy, a total of 29 publications was retrieved of which five publications were identified describing bursectomy and its outcomes in gastric cancer. These included three retrospective cohort studies and two publications from a single RCT. Bursectomy do not appear to add the morbidity or mortality of the overall surgery. However, it did not appear to significantly improve overall survival neither in the retrospective cohort studies nor in the only RCT. The evidence to date is insufficient to suggest any additional benefit of routine bursectomy to a radical gastrectomy with D2 lymphadenectomy for gastric cancer. Results of an on-going RCT are awaited to determine if bursectomy may further improve overall survival in patients with advanced T-stage of disease.

Introduction: Despite lower incidence of breast cancer in India, the total number of cases and the net mortality is high. To reduce this increasing load of mortality due to breast cancer we need to lay emphasis on early detection and increased use of systemic therapy. Early detection itself depends on early presentation to a health facility; thus, it is important to identify factors affecting delay in a presentation to hospital.Aim And Objectives: To study the clinico-social profile of breast carcinoma patients attending a tertiary care hospital and to study the time lag since detection of lump by women and presentation to the hospital and factors affecting them. Materials And Methods: A total of 120 primary breast cancer patients visiting a tertiary care hospital over a period of 7 months (August 2010 to February 2011) were taken up for study. A detailed retrospective analysis of patients was done according to planned proforma.
Observations: Maximum study subjects were in the age group of 41-50 years. Right and left breasts were equally affected. The most common histo-pathological type of breast carcinoma observed was invasive ductal carcinoma (NOS) in 105 (87.50%) cases. Majority of the cases were in stage III or stage II. The median time lag self-detection of lump in the breast by women and presentation to the hospital was 6 months. Women living in a rural area, those with lower socio-economic status and those with older age tend to assess health-care late. Conclusions: Carcinoma of the breast is a common cancer affecting young to middle age group with invasive ductal carcinoma being the most common histological type. Delay in presentation and late stage presentation is a major concern. Hence, proper awareness and screening programmers are needed to identify, inform and educate these categories of women.

Background: There is deficit of data from India on elderly patients with cancer. Comprehensive geriatric assessment may lead to a better decision making capacity in this population. However, routine implementation of such assessment is resource consuming. Aim: The aim of this study was to determine the patterns of care in elderly patients treated at a tertiary rural cancer center in India. Materials And Methods: All patients with age 70 or above with solid tumors without any definitive treatment prior to the registration at our center and registered between 01/01/2010 and 31/12/2011 were selected for this study. The baseline demographic pattern and the pattern of care of treatment were analyzed. SPSS version 16 (IBM Inc, Armonk, New York, U.S.) was used for analysis. Descriptive data are provided. Results: A total of 761 patients were evaluable subject to the aforementioned inclusion criteria. The median age of this cohort was 75 years (70-95 years). The most frequent primary sites of malignancies in 451 males were head neck (32.4%), lung (23.3%) and gastrointestinal (23.3%). In 310 females, the most common sites were head neck (31.6%), gynecological (18.4%) and gastrointestinal (24.5%). 228 (30%) of the patients had localized disease, 376 (49.4%) had loco-regionally advanced disease and 145 (19.1%) had distant metastases at presentation. 334 (46.32%) of patients were treated with curative intent. On logistic regression analysis the factors that predicted use of curative intent treatment were age <75 years, performance status 0-1, primary site and clinical extent of disease. Conclusion: Routine comprehensive geriatric assessment needs to be implemented in our setting as almost 50% of our geriatric patients undergo curative intent treatment.

Background: Nottingham prognostic index (NPI) is a widely used integrated prognostic variable in patients with breast cancer. NPI has been correlated with tumor size, grade, lymph node stage and patient survival. The present study aimed at evaluating and correlating the various clinical and pathologic features of breast carcinoma with NPI. Methods: This study included 100 consecutive cases of primary breast carcinoma over a period of 2 years. Demographic data was noted and histomorphological features like tumor size, grade, lymph node involvement, necrosis, vascular invasion etc., were assessed. NPI was calculated as reported in the literature. Immunohistochemical staining for hormone receptors and CD34 (to calculate microvessel density [MVD]) was performed. Statistical analysis was used for correlation. Results: Of the 100 cases, 54% of the tumors were in T2 tumor size category (2-5 cm) and lymph node metastasis in 48% of the cases. NPI ranged from 2.3 to 7.3 with 54% of the cases in the intermediate NPI group (3.41-5.4). The mean MVD was 160.93 (±69.4/mm2). On statistical analysis, tumor size and grade, lymph node stage, mitotic rate, nuclear pleomorphism, necrosis and MVD showed a correlation with NPI (P < 0.05). Conclusion: NPI is an important and useful prognostic indicator for breast cancer patients, which shows the correlation with other histomorphological prognostic features as well.

Context: Changes in genome, made by multiple genetic and epigenetic alterations result to the cancer initiation and progression. Suppressor of zeste 12 (SUZ12) and chromobox homolog 8 (CBX8) proteins are two components of epigenetic regulators that their function in the initiation and progression of cancers are not well-understood. Aims: The role of SUZ12 and its target CBX8 is examined. Settings And Design: Comparing the expression levels of SUZ12 and CBX8 between 30 gastric tumor and their marginal tissues. Materials And Methods: Quantitative reverse transcription polymerase chain reaction technique was performed. Statistical Analysis: Statistical comparison was carried out using Statistical Program for Social Sciences software 16.0 (Released 2007, SPSS for Windows. SPSS Inc., Chicago, IL, USA) and (GraphPad Prism version 5 for Windows, GraphPad Software, La Jolla, California USA, ww.graphpad.com).Results: Despite the obvious differences in the expression of these genes in each sample for tumor and its marginal tissue, statistical analysis did not show significant differences in the mean of expression for SUZ12 and CBX8 genes in total. Due to the variation in expression levels, the samples could be divided into two groups for each gene; group 1, in which the genes were overexpressed in tumor and group 2, in which the genes were down regulated in tumor samples. Conclusion: We found that in each group, the difference in the SUZ12 and CBX8 genes expression were significantly divergent between tumors and their marginal tissues. It means that the regulatory mechanisms involved in developing and controlling the process of gastric cancer pathogenesis is more complex than it thought. These results also bring new evidence on the possible double origin for gastric cancer development, bone-marrow-derived cells and tissue stem cells.

Background: We report on prognostic factors and long-term survival of non-metastatic breast cancer patients treated at Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH and RC) in Pakistan. Materials And Methods: This retrospective cohort study is based on a review of 2829 pathologically confirmed non-metastatic breast cancer patients managed from January 1995 to May 2009. Median age was 45 years. Stage at presentation: Stage I (9%), stage II (59%), and stage III (32%). Infiltrating ductal carcinoma (92%) constituted the most prevalent histological subtype. Estrogen (ER), progesterone (PR) and Her2-neu were positive in 49%, 50%, and 26%, respectively. A mastectomy was performed in 67% and conservative surgery in 33% of the patients. Post-operative radiotherapy was delivered in 85% of the cases. Ninety percent of the patients received chemotherapy and mainly consisted of anthracycline-based regimens + taxanes. Hormonal manipulation was done in ER/PR positive patients. Results: The 5- and 10-year overall survival (OS) was 70% (95% confidence interval [CI]: 68.2-71.8%) and 54% (95%CI: 51.2-56.8%), while disease free survival (DFS) was 65% (95% CI: 63-67%) and 52% (95% CI: 49.2-54.8%), respectively. Recurrence following primary treatment was seen in 35% of the patients. On multivariate analysis T stage, number of axillary nodal involvement, tumor grade, ER status and family history, were found to be independent predictors for OS and DFS. Conclusions: Over 90% of non-metastatic breast cancer patients present with stagesII and III disease and a significant proportion develop distant metastasis accounting for overall long-term outcome inferior to developed countries. Efforts should be directed to raise the level of health awareness and screening programs to improve early detection in Pakistan.

Aim: The aim of this study was to assess visfatin expression and its effect on human telomerase gene expression in AGS gastric cancer cell line. Materials And Methods: In this study, human gastric cancer (AGS) cell line was established as an in vitro model. Reverse transcription polymerase chain reaction (RT-PCR) and enzyme-linked immunosorbent assay was performed to show that visfatin expression in messenger ribonucleic acid (mRNA) and protein level respectively. After stimulating with increasing concentrations of visfatin for times of 24 h and 48 h, cell proliferation was assessed by 2,3-Bis-(2-Methoxy-4-Nitro-5-Sulfophenyl)-2H-Tetrazolium-5-Carboxanilide (XTT) assay. In order to investigate telomerase gene expression affected by visfatin in AGS cell line, total RNA was extracted and complementary deoxyribonucleic acid was synthesized buy using commercially available kits. Expression of human telomerase reverse transcriptase (hTERT) mRNA was carried out by real-time RT-PCR. Results: After visfatin treatment gastric cell line proliferation was enhanced and was increased the expression of hTERT. Conclusions: The obtained data showed that visfatin induces endogenously gastric cancer cell proliferation and increases telomerase (hTERT) gene expression, as a cancer gene. Based on this study, it is suggested that expression of this adipocytokine protein in real samples could be biomarker for gastric cancer.

Objective: Nucleolar organizer regions are loops of DNA containing ribosomal RNA genes and presumably are associated with ribosomal RNA activity, protein synthesis, and cell proliferation. Argyrophilic nucleolar organizer region (AgNOR) count has been suggested as an objective method in differentiating dysplastic lesions from non-dysplastic lesions. Materials And Methods: This descriptive study was done on archival paraffin blocks (n = 60), consisting of 10 normal human oral epithelium, 22 cases of non-dysplastic leukoplakia (NDLK), and 28 cases of dysplastic leukoplakia (DLK). The AgNORs were counted with the aid of a manual using conventional light microscopy and photographs of the same were taken and analyzed using Image Pro Express 6.0 (Media Cybernetic Inc., USA) for windows. Results: The mean AgNOR count per nucleus was found to be higher in patients with DLK as compared to NDLK and controls using both manual counting and image analysis method and on comparing both the techniques, image analysis provide a more accurate reflection of AgNOR counts than manual counting. Conclusion: To conclude, reliability of computerized image technique of AgNOR count is the most appropriate marker to differentiate between dysplastic and NDLK. Computer-assisted image analysis system was found to be an effective tool in achieving high reproducibility as compare to manual.

Aim: The aim of this study is to assess the efficacy and toxicity of 5-flurouracil (5-FU) and cisplatin (PF) versus taxane and cisplatin (TP) as induction chemotherapy in locally advanced head and neck squamous cell cancer. Materials And Methods: There were 50 patients in each arm, matched for age, performance state, site and stage of disease. PF arm (cisplatin - 100 mg/m2 D1, 5-FU - 1000 mg/m2 D1-D5) TP arm (docetaxel - 75 mg/m2 or paclitaxel - 175 mg/m2 on D1, cisplatin 75 mg/m2 on D2), received once in 3 weeks for 3 cycles. Patients without progressive disease underwent either surgery or chemoradiation. The primary end point was overall response rate (ORR) and secondary endpoint was toxicity. Results: In a total of 100 patients in our study, 44 in PF and 47 in TP arm were evaluable. ORR was 86.6% in PF arm and 82.9% in TP arm (P = 0.71).There were more Grade 3 or 4 events of neutropenia, mucositis (P ≤ 0.05) and myelosuppression diarrhea, febrile neutropenia (P ≥ 0.05) in PF arm compared with TP arm. Post-chemotherapy hospital admissions due to toxicity were more frequent in PF arm (38.6% vs. 19%), dropout rate due to toxicity (9% vs. 0%) and deaths (6.8% vs. 2.1%) were more common in PF arm compared with TP arm. Conclusion: TP induction chemotherapy better tolerated than PF, which has similar efficacy, further multicenter randomized controlled studies; involving a large sample size is needed to confirm our data.

Background: The significant impact of postoperative radiotherapy (PORT) on cardiac morbidity in patients of early breast cancer (EBC) undergoing breast-conserving surgery has been shown in different studies. The present study was conducted to assess the impact of surgery and the side of involvement on radiation dose to left anterior descending artery (LAD) and Left circumflex coronary artery (LCx). Materials And Methods: Totally, 58 patients of EBC were randomly chosen for this dosimetric study and planned with tangential field technique without intensity modulation (IM). Heart, LAD, and LCx (n = 55) were contoured. Dose volume histograms were analyzed to determine the Dmax (maximum dose) and Dmean (mean dose) of LAD and LCx. Student's t-test was used for comparative analysis of the means. Results: The mean Dmax of LAD for left (L) EBC was 3.17 Gray (Gy) while for right (R) EBC it was 0.86 Gy (P = 0.007;). The mean Dmean of LAD for L-EBC and R-EBC were 1.97 Gy and 0.79 Gy, respectively (P = 0.029;). The mean-Dmax of LCx for patients with L-EBC (2.9 Gy; range: 1.2–4.35 Gy) was statistically higher than that for R-EBC (1.3 Gy; range: 0.7–3.2 Gy) (P = 0.045). The mean-Dmean of LCx for L-EBC (2.1 Gy; range: 0.6–3.6 Gy) was also significantly higher than that of L-EBC (0.9 Gy; range: 0.7–2.1 Gy) (P = 0.03). There was no significant impact of the pattern of surgery on LAD dose, but significance was noted for LCx dose parameters (P = 0.04 and 0.08 for m-Dmax and m-Dmean of LCx). Conclusion: This pilot dosimetric study confirms the assumption that patients with left-sided EBC are at higher risk of developing long-term cardiac morbidity when treated with PORT due to increased dose to LAD.

Objective: The aim of this study was to compare the clinical, radiologic, and histopathological features of 28 intraosseous ameloblastomas. In addition, we compared the data obtained in this study with that of previous studies. Materials And Methods: Data with regard to age, gender, clinical manifestation, radiographic aspect, anatomical distribution, and histopathological subtypes were analyzed in 28 subjects. Results: The patients' age ranged from 7 years to 65 years (mean, 30.4 years). Sixteen (57.14%) of the 28 subjects were males, and 12 (42.85%) were females. A total of 22 cases (78.5%) were located in the mandible, posterior region was more often affected with 17 cases (77.27%) than only 5 cases (22.72%) in the anterior segment. Swelling was the most common symptom and was experienced by 12 (42.85%) patients. Radiographically, 14 cases (50%) were multilocular with a well-demarcated border. Of the remaining 14 cases, 10 were unilocular and 4 were unknown in appearance. The most common histopathological pattern was follicular followed by plexiform or acanthomatous. Conclusions: The clinical epidemiological profile to patients in the present study is similar to that in other populations, with follicular ameloblastoma being the most common histological subtypes seen.

Background: Cisplatin and 5 fluorouracil drug combination is inferior to the combination of taxane with these 2 drugs. However, often in clinical practice at our center giving TPF (docetaxel, cisplatin, 5 fluorouracil) is difficult in view of logistics and tolerance issues. In such a scenario, we prefer to use the 2 drugs combination of platinum and taxane. However, no study has addressed whether a 2 drugs combination, which includes taxane is inferior to the 3 drugs combination and which the taxane of choice is in the 2 drugs combination of taxane and platinum. Methods: This is a retrospective analysis of prospectively collected data of patients undergoing induction chemotherapy (IC) in oral cavity cancers from 2010 to 2012. We chose for analysis those patients who had a baseline scan done within 4 weeks of starting therapy and a follow-up scan done within 2 weeks of completion of the second cycle of IC. Response was scored in accordance with RECIST version 1.1. Chi-square analysis was done to compare response rates (RRs) between regimens. Results: Two hundred and forty-five patients were identified. The median age was 45 years (24–70 years), 208 (84.9%) were male patients, and 154 patients (62.9%) had primary in the Buccal mucosa. The regimens received were TPF 22 (9%), docetaxel + cisplatin 97 (39.6%), paclitaxel + cisplatin 89 (36.3%), docetaxel + carboplatin 16 (6.5%) and paclitaxel + carboplatin 21 (8.6%). The overall RRs were complete response, partial response, stable disease and progressive disease in 4 (1.6%), 56 (22.9%), 145 (59.2%) and 40 (16.3%). The 3 drugs regimen (TPF) had 50% RR as compared to 22% RR with 2 drugs regimen (P = 0.004). Docetaxel containing regimens had 30.3% RR as compared to 17.2% RR with paclitaxel containing regimens (P = 0.094). Conclusions: TPF has better RR than a 2 drugs taxane-containing regimen and docetaxel leads to a better RR than paclitaxel for IC in locally advanced oral cavity cancers.

Background: Gastric cancer is a forth common malignancy world-wide and the second most common cause of cancer-related deaths. According to the current International Union Against Cancer staging system, nodal status is categorized based on the number of metastatic lymph nodes (LNs). Some groups have recently proposed the metastatic lymph node ratio (MLR) (the ratio between metastatic LNs and total dissected LNs; MLR) as an alternative prognostic factor. The aim of the present study is to evaluate the relationship between MLR and different clinico pathologic factors including patients' age, tumor grade, stage, sites of involvement and disease prognosis. Methods: Atotal of 70 patients with gastric adenocarcinoma who underwent gastrectomy with negative margin and LN resection during 2004-2009 and were referred to Radiotherapy-Oncology Department of Name of Hospital, Name of City, were included in the study. MLR status was divided to five groups. Collected data were analyzed with SPSS 16 (SPSS Inc., Chicago, IL, USA). Results: The difference between MLR groups in age was significant; older patients had lower MLR (P = 0.01). The ratio of male to female was 5.3, which indicated higher prevalence of gastric cancer in males. The difference between MLR groups for tumor location, tumor stage, disease free periods and tumor T stages were not significant. A significant relation existed between different stages of LN involvement and MLR; and also between cancer stages and MLR. Conclusion: We found a significant relation between MLR and cancer stage and metastatic LN. Due to small sample size and short period of follow-up, we could not find significant relation between MLR and other factors such as depth of tumor invasion, disease free period and tumor grading. In conclusion with regards to our results and other similar studies' results, we acknowledge the importance of MLR in determining patients' prognosis in gastric cancer.

Background: Patients with cancers in the head and region are at increased risk of developing synchronous primary cancers. AIM: The aim of this study is to see the role of endoscopy in the pre-therapeutic works-up of patients with the cancers in the head and neck region. Materials And Methods: Data of head and neck cancer patients from January 2010 to December 2011 were obtained from the hospital cancer registry for retrospective analysis of patients with synchronous cancers. All synchronous malignancies were analyzed for distribution of sites, association with smoking history and the average age of patients at presentation with synchronous cancers. The Chi-square test for association of upper aero digestive tract (UADT) and smoking and statistical formula of mode for average age have been employed for analyzing results. Results: Incidence of synchronous primaries has been found to be 1.43% and mostly males were affected. The common index sites for synchronous primaries are oropharynx 22 (36.6%), oral cavity 14 (23.3%), hypopharyx 12 (20%) and larynx eight (13.3%) cases in decreasing order, 58.3% synchronous occurred at esophagus and 0.83% of all head and neck cancers developed synchronous primary at esophagus. Association of UADT synchronous cancers with smoking (odds ratio = 13.42, Chi-square 7.12 at 95% confidence interval, P = 0.0076) is highly significant and the average age is 62.6 years in males and 62 years in females. Conclusion: Endoscopy can be rationally used during the pre-therapeutic work-up of patients with a history of smoking and/or in patients over the age of 62 years. Instead of complete upper gastro intestinal endoscopy up to the second part of duodenum, only esophagoscopy is needed for the detection of synchronous primary of upper aero-digestive tract in cancers of the head and neck region.

Background: Gastric cancer is the first cause of cancer death in Iran. Most of the patients are diagnosed in advanced stages and survival rate is low. The aim of this study was to evaluate the survival rate of patients with gastric and gastroesophageal junction adenocarcinoma receiving combination chemotherapy and radiation therapy in Iran. Materials And Methods: This study was conducted on 53 patients with gastric or gastroesophageal junction adenocarcinoma referring to Shahid Ramezanzadeh Radiation Oncology Center between 2004 and 2010. All patients underwent surgical operation, chemotherapy, and radiotherapy. Data contained in patients' records were extracted and follow-up was conducted through telephone contacts. To analyze the data, Kaplan Meier curves, and SPSS software were employed. Results: Seventeen (32.1%) patients were female and 36 (67.9%) were male. Mean age was 58.32 years. In 14 patients (26.9%) no lymph node was resected or reported by the pathologist. In 29 patients (54.7%) one to six lymph nodes were found, and in10 patients (18.9%) seven lymph nodes or more were detected. In two patients, (3.77%) more than 15 lymph nodes were resected. Surgical staging was impossible for 16 patients (30.2%). Mean survival was 50.9 months and median survival was 51 months. 3,5 and 7 year survival rates were 73%, 36%, and 18% respectively. None of the variables had a significant relation to survival. Conclusions: Despite inadequate surgery, the survival rate in our study is one of the best one reported in our country. We think this advantage may be due to poly drug chemotherapy and sequential radiation therapy.

Background: The prognostic relevance of histologic differentiation in gastric carcinoma patients with curative resection is unclear. We analyzed the clinicopathologic features of gastric carcinoma patients with curative resection according to the histologic differentiation and evaluated surgical outcome. Materials And Methods: Of 1198 gastric carcinoma patients with curative resection (American joint committee on cancer, Stages I-III), 274 (22.9%) had well-differentiated, 331 (27.6%) had moderately differentiated and 593 (49.5%) had poorly differentiated gastric carcinomas. Results: Patients with the poorly differentiated type had more prominent serosal invasion, much more lymph node involvement and more advanced stage than patients with the well-differentiated type. The overall survival rate was higher for patients with a well-differentiated gastric carcinoma than for patients with a poorly differentiated type. Using Cox's proportional hazard regression model, histologic differentiation was found to be a statistically significant prognostic parameter (risk ratio, 1.41; 95% confidence interval, 1.028-1.922; P < 0.05). Conclusion: Our results suggest that patients with a well-differentiated gastric carcinoma have a good prognosis compared with those with a poorly differentiated type. Therefore, histologic differentiation can be used as a prognostic indicator in gastric carcinoma patients with curative resection.

Background: Development of oral cancer, a widely prevalent cancer in India, is multifactorial with increased risk in those habituated to smoking, consuming alcohol and chewing paan and tobacco. This does not preclude other etiological factors in the causation of this cancer. Exploratory studies on several oncogenic viruses have found varied associations with oral cancers.Aim: The aim of this study was to explore the association of xenotropic murine leukemia virus-related virus, (XMRV) a retrovirus recently implicated in oncogenesis in humans, with oral cancers.Settings And Design: The presence of XMRV proviral deoxyribonucleic acid (DNA) was evaluated by standard nucleic acid amplification from DNA extracted from representative bits of tumor tissues and adjacent normal tissues from surgically resected specimens sent post-operatively for routine histopathological testing.Materials And Methods: This prospective study comprised 109 patients with a provisional diagnosis of oral cancer who were operated at the Oral Oncology Department of Kidwai Memorial Institute of Oncology, over a period of 10 months.Results: XMRV was not found in any of the tumor tissues (squamous cell carcinomas - 98; verrucous carcinomas - 4) nor in any of the normal tissues. It is thus important that the absence of this oncogenic virus in all the cases makes the association of XMRV with oral cancers very unlikely.Conclusions: There is a need to investigate potentially oncogenic viruses in other solid tumors and in larger sample sizes. Any such association could have implications in detecting, preventing and treating these cancers.